Abstract
Background
Burnout is a globally recognized occupational phenomenon characterized by varying degrees of depersonalization, emotional exhaustion, and a decreased sense of personal accomplishment. 1 Among health care professionals, burnout is of growing concern, negatively affecting both personal wellbeing and professional performance. 1 Burnout poses significant risks to patient care, as it is associated with diminished work quality and increased staff turnover. 2 Burnout has been well documented in physician and nursing literature; however, it remains underexplored in pharmacy. Burnout rates among critical care pharmacists have been reported as high as 64%. 2 In addition, associations were found between higher levels of reported burnout and factors, such as the schedule of shifts being worked and higher pharmacist to patient ratios.3,4 The emergence of health crises, similar to the COVID-19 pandemic, has further contributed to these challenges, forcing pharmacy professionals to adapt rapidly to evolving demands.
Burnout is assessed using validated questionnaires, including the Maslach Burnout Inventory (MBI) and the Oldenburg Burnout Inventory (OLBI). The MBI evaluates 3 areas of burnout: emotional exhaustion, depersonalization, and personal accomplishment. 5 However, concerns about the unidirectional framing of its items led to the development of the OLBI, which improves psychometric robustness and enhances the measurement of exhaustion. 6 The OLBI focuses on 2 areas: exhaustion and disengagement from work. 6 Exhaustion is defined as the consequence of intensive physical, affective, and cognitive strain and disengagement focuses on the relationship that participants have with their work. 6 Positive items are reverse coded so that higher scores indicate a higher level of burnout. 6 By incorporating both positive and negative thoughts on the current state of reported burnout, this tool can assess the nuances of burnout and its potential protective factors.
Research has explored the prevalence and predictors of burnout among pharmacy professionals. A study from Petrino et al examined burnout levels 2 years after the peak of COVID-19 infections in emergency medicine personnel, finding that 62% reported burnout symptoms, while only 41% had access to psychological support. 7 Similarly, a systematic review from Dee et al analyzed data from 11,306 pharmacists to characterize burnout and potentially associated factors. 8 Protective factors included participation in peer education, scheduled time away from work, social engagement, and access to burnout management resources—although specific resources were often undefined, and data on accessibility remained limited.
In this study, we sought to assess the level of burnout and exhaustion among critical care and emergency medicine pharmacists using the OLBI, identify the availability of employer-provided resources, and examine the relationship between resource utilization and burnout outcomes. In addition, free-text responses were collected to allow participants to identify factors they felt contributed to burnout, as well as themes that leadership could address to provide comprehensive support.
Methods
This study was a prospective, online, descriptive, and exploratory survey to capture the current levels of burnout among emergency medicine or critical care pharmacists, generating insights into the resources pharmacists utilize to manage burnout. The survey included demographics, employer-based resources, questions about burnout, and free-text responses. Demographics included gender identity, clinical specialty area (i.e., critical care, emergency medicine, both), years in practice, highest level of education achieved, workplace location (i.e., state), trauma center category, number of hospital beds at primary work site, typical shifts, and hours worked, whether the participant is an active preceptor, and whether the participant has experienced workplace violence. Employer-based resources included clinical support, mental health, general wellness, burnout prevention training, and formal peer support. Two free-text questions were used to collect qualitative data and asked about resources participants wished were available to prevent burnout and a space to leave additional comments.
To quantify burnout, we used the OLBI with author permission. Scores range from 16 to 64, with a total score of 30 or higher indicating moderate burnout. The disengagement and exhaustion subscales range from 8 to 32, with a score of 22 or higher in the disengagement subscale indicating severe disengagement and a score of 16 or higher in the exhaustion subscale indicating moderate exhaustion. 9
Eligible participants included self-identifying pharmacists practicing in emergency medicine or critical care and a willingness to participate. Survey data were collected and managed using REDCap electronic data capture tools hosted by the University of Vermont. 10 The surveys were distributed to potential participants by convenience sample, via direct email invitations, forwarded by colleagues, or through announcements shared via email chains or listservs. The data collection period spanned from December 20, 2024 to February 14, 2025, with reminder emails sent at 2- and 4-week intervals following the initial survey invitation. This study was approved by the University of Vermont and University of Vermont Medical Center’s Institutional Review Board (STUDY00003343).
Only fully completed surveys, including all mandatory questions, were included in the final analysis. Quantitative data were analyzed using descriptive statistics to summarize demographic characteristics and burnout levels. For hypothesis testing, inferential statistical methods including analysis of variance (ANOVA) and Student t tests were employed to assess differences in burnout levels based on demographic variables, such as region, years of experience, and workload. Three multivariable linear regression models were created for total burnout score, exhaustion, and disengagement. Variables with P < 0.2 versus the outcome score in the univariate analyses were included in the multivariable model as recommended by Vittinghoff et al. 11 Backwards selection was used until only statistically significant variables at P < 0.05 remained in the final models. Quantitative data were analyzed using SAS 9.4 (Cary, NC: SAS Institute Inc).
Qualitative data were reviewed and initially independently coded by 3 coauthors. After independently coding responses, the reviewers met to discuss the coding rubric, resolve discrepancies, and ultimately reach consensus on the final coding. Codes were organized under major themes. The second question, “is there anything else you would like us to know?” was analyzed by the authors considering whether the statement indicated a new code not previously identified by the resources question.
Results
A total of 354 survey responses were received with 346 included in the final analysis (Table 1). A total of 250 (72.1%) responses were from female participants. 50% of responses were from emergency medicine pharmacists. The total included responses in the analysis for variables, such as gender, area of specialization, and years in practice do not equal the overall study population of 346 surveys due to missing responses. There was even distribution between time spent practicing in a specialty with 121 (35%) practicing for <5 years, 128 (37%) practicing for 5 to 10 years, and 96 (28%) practicing for >10 years, respectively. The majority of respondents completed postgraduate year 2 (PGY2) pharmacy residency training, comprising 62.7% of respondents. Responses were received from all 4 census-designated regions of the United States with the most responses coming from the South with 35.6% of responses. There were no differences in reported burnout scores per the OLBI between those practicing in a trauma center and the number of beds within an institution. Nearly half (48.7%) of respondents reported typically working the day shift.
Survey Results (N = 346).
Two-sample T test for 2 groups, analysis of variance for > 2 groups.
PGY1 and PGY2 refer to postgraduate year 1 and postgraduate year 2 pharmacy residency programs, respectively.
One quarter of pharmacists (25.3%) reported experiencing workplace violence. This included 10/111 (9%) of critical care pharmacists, 63/170 (37%) of emergency medicine pharmacists, and 13/59 (22%) of pharmacists who specialize in both areas. There was a statistically significant difference in experiencing workplace violence across groups (P < 0.0001) and when comparing emergency medicine with critical care (P < 0.0001). There were no differences between those who experienced workplace violence and those who did not experience workplace violence on the total burnout score (P = 0.90), or the exhaustion (P = 0.98) or disengagement (P = 0.84) subscales.
The mean total burnout score was 39.1 (SD = 7.1) with the mean exhaustion subscale score of 20.5 (SD = 3.8) and disengagement of 18.6 (SD = 3.9). Variables that were found to have a statistically significant association with overall burnout in univariate analyses included 5 to 10 years in practice, PGY2 residency training, not having access to general wellness resources, no burnout prevention training, no formal peer support, and an increased anticipated frequency of utilization. Of note, for the formal peer support category, the mean burnout scores varied by 3 points, 36.9 for those with formal peer support compared with 39.9 for those without formal peer support (P = 0.001).
Variables that were retained in the overall multivariable model that were associated with total burnout included time in practice, level of clinical training, access to employer-based general wellness resources and access to employer based formal peer support (Table 2). Variables associated with the exhaustion subscale included gender, area of specialization, and access to burnout prevention training and peer support (Table 3). Male gender and specializing in both emergency medicine and critical care were found to be protective for exhaustion, while a lack of burnout prevention training and peer support were associated with increased exhaustion. Variables associated with disengagement included time spent in practice, level of clinical training, and access to formal peer support (Table 4).
Multivariable Analysis of Total Burnout Score a .
Total score: range 16 to 64 (higher score = higher burnout).
PGY1 and PGY2 are postgraduate year 1 and postgraduate year 2 pharmacy residency programs, respectively.
Multivariable Analysis of Exhaustion Subscale.
Multivariable Analysis of Disengagement Subscale.
PGY1 and PGY2 are postgraduate year 1 and postgraduate year 2 pharmacy residency programs, respectively.
For resources available to pharmacists, most reported clinical support during shifts (93.3%) and mental health resources (80%). However, access to other resources was low, including access to general wellness (36.7%), burnout prevention training (26.7%), formal peer support (27.1%), and other resources (10%). Current utilization of these resources is evenly split between daily/weekly/monthly and less than monthly with 160 (46.4%) and 185 (53.6%) reported, respectively. Almost all participants reported these resources were not required to be used by their employers (340, 99.4%).
Participants were given the opportunity to indicate resources they wish were available for managing burnout in a free-text response section (Table 5). The most common themes to these responses were improved scheduling, scheduled nonclinical time, and improved staffing ratios. Additional themes included general wellness programming, peer support, leadership, education, and having learners present on rotation. Within the quotes contained from the free-text responses, pharmacists clearly identified that having time away from work, whether in the form of a day off or as a scheduled break, was vital to maintaining their mental health and wellbeing.
Participant-Reported Suggestions for Employer-Based Supports for Preventing Burnout.
Discussion
Overall, we found that pharmacists working in critical care and emergency medicine have moderate levels of burnout, and moderate exhaustion and disengagement. Factors, such as completion of PGY2 residency training, time spent in practice, and a lack of access to resources, such as general wellness, burnout prevention training, and formal peer support, had a statistically significant association with burnout. A lack of formal peer support provided to pharmacists was also associated with burnout in all 3 multivariate analyses. In addition, time in practice of 5 to 10 years and PGY2 residency training were found to have statistically significant higher total burnout and disengagement scores. Although these factors did not hold statistical significance in all 3 models, it is still important to note, as age and time in practice have previously been identified as contributing factors to burnout in other studies. 12
The results of our study indicate that only about half of pharmacists utilize the resources that are available to them, and few resources are readily available from their employers. Similarly, the free-text responses from participants indicate that there are many desired but not available resources. The most common categories of desired resources included improved staffing ratios, improved scheduling, and scheduled nonclinical time. The data from these responses and our findings with regard to influencing factors will be important for pharmacy and hospital leadership when designing their approach to burnout prevention.
Although not a major theme within the free-text responses of the survey, Code Lavender was suggested as a resource model. Code Lavender was first identified in the early 2000s as an intervention to provide caregivers with emotional support. 13 It follows an evidence-based relaxation technique to help professionals meet their responsibilities and create long lasting coping mechanisms. 14 By addressing these crises in real time, pharmacists can reflect on the situation at hand and feel supported in the moment. In addition, this program creates an avenue for leadership to be aware and directly involved in maintaining the wellbeing of employees. Given the increasing rate of resignation among pharmacists working within acute care areas, it is important to address their needs in a timely manner. Similarly, a pilot study by Gruber et al, which designed a Code Lavender intervention program within a 20-bed intensive care unit, found that those who utilized the counseling services were happy to have a place to take a break from the stress of their work, noting that they felt supported from discussion. 13 The study also estimated that from the use of these services, there are potential cost savings to the hospital from reduced job turnover. 13 This service is a strategy that should be further explored and implemented at institutions to provide further emotional support and assist pharmacists and other health care workers with developing strategies for managing their stress to prevent burnout.
Most of the available data on burnout are derived from physician populations with a focus on individual interventions relating to mindfulness. In a meta analysis reviewing the interventions available to reduce the long-term effects of stress in physicians, cognitive, behavioral, and mindfulness-based activities significantly reduced symptoms of anxiety. 15 Mindfulness resources examined within this study included meditation, psychoeducation, and interpersonal communication. 15 While these resources are important in preventing burnout, they still have not addressed strategies and programs that may be available from employers to alleviate symptoms of burnout. In addition, there is little information existing to assess the availability of resources and their reported utilization.
In a study surveying critical care pharmacists using the MBI to assess the risk of burnout, it was estimated that 64% of respondents were identified as burned out. 16 Within their sample of 193 complete responses, 83 were identified with a score >27 for emotional exhaustion, which indicates a higher degree of burnout. 16 While this study estimated burnout within this population, there were no contributory factors identified. When comparing known risk factors for burnout, such as years of practice or number of beds per hospital, there were no statistically significant differences found between those identified with burnout and those without. 16 Similarly, a national pilot study aimed at assessing factors influencing burnout determined a similar burnout rate of 61.2%, which was primarily influenced by emotional exhaustion. 12 While older age was found to be a protective factor for the development of burnout, factors including the feeling of being underappreciated, having too many nonclinical activities, uncertainty regarding changes in health care, inadequate time for teaching, administrative activities, and difficult relationships colleagues were found to increase the odds of burnout. 12 This information is important when considering how leadership and institutions should respond to burnout concerns.
There are a few important strengths to mention regarding this study. First, the survey captured a large sample. In addition, the use of the OLBI to assess burnout allows analysis of burnout from both a positive and negative perspective. This helps to balance the perspectives and attitudes that respondents have toward the topic. Second, this was a nationally conducted survey and received responses distributed across all 4 geographical regions of the United States. By having a more diverse population of respondents, the results of this survey are more applicable to the profession of pharmacy across all American regions.
A key limitation of this study is the use of snowball sampling, which restricted the ability to calculate a true response rate, as the total number of individuals who received the link to participate is unknown. In addition, this method may have introduced selection bias as participants were likely recruited through personal and professional networks, resulting in a sample that may not fully represent the target population. There is also an inability to confirm that there were no duplicate responses. Furthermore, the population of responses comprised 73% female respondents. It is estimated the current breakdown of the pharmacy workforce in 2023 was 59% female; however, subspecialty gender breakdown is not assessed. 17 Our responses also came from pharmacists who were in practice for 10 years or fewer. Both the distribution of gender and time in practice affect the applicability of these findings to the national pharmacist population. It would have been interesting to describe the typical staffing ratios of the participating pharmacists; however, we did not collect this information as part of our survey. Martello et al estimated that most hospitals are recommended to follow ratios between 1:8 and 1:30 depending on clinical area. 18 In addition, with self-reported surveys, there is potential for the introduction of reporting and recall bias. Importantly, we found 25% of pharmacists indicated experiencing workplace violence. We did not anticipate such a high proportion of workplace violence reporting. In the field of nursing, data from Pascale et al found a mean incidence of 2.93 acts of workplace violence per full-time equivalents (FTEs) with a range of 0 to 7.12 acts of workplace violence per 100 FTEs. 19 The increasing prevalence of workplace violence among health care workers is of concern. Additional questions should be explored in a future study to better understand this critical finding.
Conclusion
In conclusion, the results of this survey demonstrate moderate burnout among emergency medicine and critical care pharmacists, and a strong desire for increased leadership support. Multivariate analyses revealed that strategies, such as implementing a formal peer support program could help reduce burnout and improve the wellbeing of acute care pharmacists. More research should be directed toward mental health initiatives, such as Code Lavender, which have the potential to greatly improve forecasted burnout. Hospital leadership can help support their emergency medicine and critical care pharmacists by implementing formal peer support programs and encouraging pharmacists to advocate for burnout prevention resources.
Footnotes
Data Availability
All data generated or analyzed during this study are included in this published article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval and Consent to Participate
This study received ethical approval from the University of Vermont IRB (approval no. STUDY00003343) on October 17, 2024. This is an IRB-approved survey study, all pharmacist information was de-identified and pharmacist consent was not required.
